The radical blueprint the NHS needs to survive life after Brexit

The NHS wasn’t on the Brexit ballot. But it often felt as if it was. Emblazoned on the Battlebus, both Leave and Remain wrapped themselves in the mantle of a strong and better funded health service.

This was curious, as on the NHS there is no overriding need to 'take back control’. We already make the big decisions about our health system largely as we please, as do the Germans, the French and the rest.

But if the referendum result revealed a country divided, on the NHS it confirmed a nation united – by deep pride and genuine concern for our most important social institution.

Would Brexit liberate £350 million a week for the NHS? Or would it dent the public finances just as health service needs more public money? And how best to manage immigration, without inadvertently triggering hospital and care home closures, relying for years on 130,000 European nurses, doctors and other staff?

The NHS was at the heart of the referendum battleCredit:
Getty

These questions matter profoundly, but the challenges facing the health service go far wider. They require bold and broad reforms.

First, if you’re concerned about life chances you need to act on prevention and health inequalities. While smoking explains half the difference in longevity between rich and poor, obesity is the new smoking: poor diet is now our biggest avoidable cause of ill health.

Piling on the pounds around our children’s waistlines is piling on billions in future NHS costs. We now spend more on obesity than on the police and fire service combined.

Second, how NHS care is provided needs a major overhaul. Access to GPs was a repeated public concern during the referendum campaign. We make 300 million visits to GP practices each year, compared to fewer than 25 million A&E attendances. So if GP services fail the NHS fails.

Yet headlines about hospital deficits obscure the fact that over the past decade their share of funding has grown rapidly at the expense of primary care, and hospital consultant numbers have expanded three times faster than GPs.

Every part of the country is now getting on with the NHS’ Five Year Forward View. It’ll mean better joined-up GP and hospital services, better links with social care, earlier cancer diagnosis, and streamlined access to urgent and emergency care – seven days a week.

And as Theresa May pointed out last week, mental health is the poor relation. Today we publish a blueprint showing how a million more people will get the specialist help they need each year. It sets out chapter and verse on better mental health for young people and new mothers, seven day crisis care to keep people out of the criminal justice system, and far wider help for depression, anxiety and other common conditions.

Third, many patients arrive each day for their GP or hospital appointment in what are – can we speak frankly? – overcrowded and clapped-out buildings in need of a makeover, if not a bulldozer. Yet to help balance the books, the NHS is currently switching billions of pounds of capital investment into day-to-day running costs.

When you’ve got lemons, make lemonade. UK government borrowing costs are now the lowest they’ve been since the Napoleonic wars. Instead of inflexibly expensive PFI, howabout a substantial NHS 70th Birthday Public Fund for Infrastructure? It’d create optimism across the NHS, unleash major efficiencies, turbocharge the construction industry, and be welcomed in across the country.

Fourth, as the largest employer in Europe, the NHS needs to do a better job training and looking after our own staff. New apprenticeships can help many “left-behind” communities alienated from modern Britain.

It should be completely uncontroversial to provide early reassurance to international NHS employees about their continued welcome in this country

Even then we’re still going to need committed professionals from abroad. Australian-style immigration points systems all admit nurses, doctors and other skilled experts. It should be completely uncontroversial to provide early reassurance to international NHS employees about their continued welcome in this country.

Fifth, while the NHS is the world’s cheapest high-quality health system, there are still major efficiencies to be had. Care is variable, procurement fragmented, assets used ineffectively. This year will see decisive action to get hospital finances back on an even keel, with last year’s deficit cut dramatically.

The most immediate need is social care. If home care disappears and care homes close, A&Es are quickly overwhelmed. We need creative solutions. Give retirees more personal control over how care, health and benefits funds are together spent on their behalf? Expand the so-called 'triple lock’ on pensions to encompass care costs? LET councils take back democratic control over earmarked social care funding increases?

The need for radical change is now. We know what needs doing. Let’s get on with it.